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Everyone is writing and speaking about the future of technology in health care delivery. But talk about where health care technology is going should be over..it's here. Like it or not, technology is a necessary component in the delivery of quality patient care, as well as in the financial success of hospitals, physicians' practices, long-term care facilities, home care agencies and other allied health care companies. Its use is the only way to survive in an industry fraught with regulatory oversight, consumer demands and increasing information. We will discover more medical facts about the human body in the next 10 years than we have in the whole history of medicine--can doctors really learn and apply this explosion of knowledge? They may have no choice. For the reality is this: health care will never go back; it will never be the same, ever.

Already physicians can document their physical exam findings using speech recognition onto an electronic medical record (EMR); view their hospitalized patients' charts; actually see the patient and conference with other physicians while not being physically present; plus, they can electronically transmit prescription orders as well as claims for reimbursement. They can do this today using available technology. Yet, this incredible advancement in health care delivery has not yet been embraced, or put to use, by the vast majority of health care institutions or professionals.

"640K ought to be enough for anybody."[1]

From 1991-1993, I had the pleasure of being part of an elite, international group of technology experts, health care professionals, academics and business and financial specialists in the creation of what was to be a "state-of-the-art" hospital, which would implement the first ever EMR in Glasgow, Scotland. It worked!

We offered international patients the opportunity to be seen in their country while the results and details of consultations were transmitted to our Glasgow facility, enabling us to have their latest clinical details combined with relevant tests and investigations. Once in the hospital, patients were seen by doctors who immediately documented that interaction in strategically placed computers. These same computers were also found throughout the hospital to allow interaction with the clinical record at any time during the patients' hospital stays. Upon patient discharge, the documentation was ready for transmission to their referring physician, though sadly this meant printing the record and sending it in paper form because most physicians did not have the capacity to receive electronic transmissions. However, in the last 10 years, while technology has progressed significantly, its widespread support and use by health care professionals and executives have not.

But the Federal Government is now on board. Health and Human Services (HHS) Secretary Tommy Thompson recently announced new steps in building an electronic health system that will allow patients and their doctors to access their complete medical records, anywhere, anytime, an act which it believes will lead to reduced medical errors, improved patient care and reduced healthcare costs. Yet astonishingly, the reception by the medical community to implementing anything other than billing technology is like telling the 1899 U.S. Patent Office commissioner, Charles Duell, there are more inventions to come. [2]

"We've met the enemy and it is us."[3]

Laura Landro reports in her recent article in the Wall Street Journal that doctors need incentives to use technology.[4] Landro quotes extensively from a Deloitte Research report, "Clinical Transformation: Cross-Industry Lessons for Health Care," which calls for "a complete overhaul in the way hospitals and doctors are compensated and rewarded" (to use technology). Landro quotes the report as saying that doctors need "financial aid, user-friendly systems and more support from hospital executives."

Frankly, I don't think this is the answer. The truth is the major reason adoption of technology by doctors is failing centers on the archaic way physicians treat patients and document that activity. Physicians are still set in a paradigm of limited knowledge of the human body. The rate of knowledge development in medicine seems to match the principles of Moore's Law for computation power.[5] In "my law", I believe there will be a doubling of medical knowledge at least every two years.

In the last 10 years, we have developed whole new branches of medicine based on the genome. Yet up until now, most doctors practice medicine based on the short list of differential diagnoses for the complaint with which the patient presents. As Larry Weed[6] said, "New information tools enable us to leave behind a world of medical practice in which providers and patients alike are the victims of the 'predictable and undesirable internal constraints' of the unaided human mind."

Tied to changes in clinical practice is the way medical records are used for documentation. The medical record was originally designed to allow communication between clinicians about the status of their patient. But this activity has been hijacked by coding and billing and no longer provides that communication. Money has become the driver of this train as evidenced by the fact that more than 80 percent of physicians use computerization and newer technology in their billing offices, while less than 50 percent of them use technology for clinical, documenting, information transfer issues.[7]

What the medical community needs to understand is that financial issues are everywhere in health care, not just lying in the business office. How costly is it to administer a wrong medication? (Wait, forget cost, how much personal damage do we do by administering the wrong medicine to our patients?) Not to be able to see and review a patient's medical record at the time of the clinical consultation? How much time does it take to learn a new clinical protocol, new drug or new regulation? Physicians can no longer continue being a receptacle for a constant barrage of information related to advances in treatment protocols, clinical trial outcomes and confusion about patient health insurance coverage, including pre-authorization requirements, and still manage to keep up with the new drugs produced each year. The facts are so simple: with one touch of a screen, one call to a speech recognition device, use of a PDA, cell phone, lap top, Internet, all this information is retrievable and useable--and in a matter of moments, not hours or days.

"Being big or small isn't the crucial issue. If you don't move, you don't move."[8]

For those of us who practice, manage, insure, care for, treat or otherwise serve health care, the challenge is to get real and accept that technology must become an integral part of our fields of practice. For those of us in the health care technology field, the challenge to meet the needs of a diverse client base, build customer loyalty, educate and overcome the inherent obstacles in the health care industry related to technology, compete in an ever increasing field and remain on the "cutting edge" of newer advances, is not our future, it is our reality.

We must:

·        Deliver solutions that provide real benefits, quickly;

·        Persuade the clinicians that their practice must incorporate technology now into every aspect of health care delivery; it is no longer acceptable to claim ignorance related to the patient history or to the latest advances in therapy that would bring positive outcomes;

·        Strive for six sigma care-the highest level of quality, driving out all errors from the system. There is a reason the airline industry has a six sigma error rate. Imagine the outcry or the decline in passenger volume if airlines had the error rate we currently accept in medicine: one airliner per day would be lost with all on board!

·        Follow the six sigma model and use technology to support the clinicians delivering the highest possible quality of care.

The next generation of health care technology is here, with visionaries and futurists pushing the envelope to enhance, create and generate the newest cutting edge in health care delivery. Advances in technology, like advances in medicine, are a shared entity that enhances life expectancy and the quality of life.

References

1. Bill Gates, 1981
2. 1899 US Patent Office commissioner resigned stating "Everything that can be invented, has been invented"
3. Pogo
4. Laura Landro, "Doctors Need Incentives To Embrace Technology", Wall Street Journal, July 9, 2003
5. Charles Moore, co-founder Intel, See Moore's Law at ftp://www.download.intel.com/research/silicon/moorespaper.pdf  and The Jargon Dictionary, Version 4.2.2, August 2000 at http://www.
6. Larry L. Weed, "New Connections Between Medical Knowledge and Patient Care", British Medical Journal, 1997, 315-231-235 (see http://bmj.com/cgi/content/full/315/7102/231
7. Modern Physician Magazine, survey of 444 physicians, July 2002
8. Steve Ballmer, CEO, Microsoft
 

Dr. Nick van Terheyden is chief medical officer, SoftMed Systems.


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